Why is Anti-Estrogen Therapy Important?

Men have testosterone and women have estrogen, and never the twain shall meet, except in the occasional female shot putter from some former Soviet bloc country.

That’s the way most people think of the relationship between testosterone and estrogen, but the truth is a lot more complicated. Women need a certain amount of testosterone for proper sexual functioning and health. Conversely, men need a certain amount of estrogen for the same reasons.

Even though these hormones are regarded as the yin and yang of human sexual behavior and development, molecularly they’re remarkably similar. In fact, you could even merge the two molecules into one three-dimensional figure and they’d be identical except that testosterone would have one little extra carbon atom sticking straight up from the molecular bridgework.

And in this structural similarity lies a hint to why conscientious hormone replacement doctors are concerned with how much estrogen a man has in his body and it has to do with how easily testosterone is converted into estrogen.

The Danger of High Estrogen Levels

There’s an enzyme floating around in the bloodstream of men and it’s called aromatase. What it does is convert testosterone into estradiol, a more potent form of estrogen.

Nature gave us aromatase for a reason, though. If you’re making too much testosterone, the increased amount of estrogen, courtesy of the aromatase enzyme, tells your pituitary gland to signal to the testicles that they’re making too much testosterone and that they need to back off.

They of course do, and testosterone levels fall, as well as estrogen levels (because there’s less testosterone to convert into estrogen). It’s really quite elegant.

Sometimes, this delicate do-si-do dance loses its rhythm and estrogen levels start climbing all on their own, usually because of age, obesity, chemicals in the diet and the environment, or genetics.

Likewise, the older you get, the more aromatase you have in your body naturally and the more you convert testosterone into estrogen.

When aromatase levels are too high, too much testosterone is converted into estrogen, which can cause men to be low on testosterone and high on estrogen, and that’s a bad situation.

Of course, to be fair, doctors have recently begun to show some interest in male estrogen levels, but the conclusions they’ve drawn are disturbingly two-dimensional and short sighted.

Here’s the thing. A study published in the Journal of the American Medical Association examined the estrogen levels of 501 men with chronic heart failure. The men with estradiol levels in the normal range (between 21.80 and 30.11 pg/ml) had the fewest deaths during a 3-year follow up, while the men with estradiol levels in the highest range (above 37.39 pg/ml) had 133% more deaths during this time period.

The men with estradiol levels in the lowest range (below 12.90 pg/dl), however, had 317% more deaths!

The doctors who wrote up the study concluded that yes, men need estrogen (tell us something we didn’t know!). The trouble is, the majority of the docs who read the abstract or heard about the study got stuck on that one fact – that men need estrogen – and they didn’t take the next, small, deductive leap.

Since they realized that men need estrogen for heart health, they’re now loathe to prescribe any estrogen suppressing drugs for men who have high levels. Essentially, they completely glossed over the death rates of men who have cardiac problems because their estrogen levels are too high.

Estrogen and Testosterone Replacement Therapy

There’s one other situation where it might be important to counter rising estrogen levels, and that’s in those men receiving testosterone replacement.

In fact, it’s not a stretch to say that in most cases, testosterone replacement and anti-estrogen drugs (anti-aromatases) go hand in hand.

It makes sense, after all. If your testosterone levels are below optimum and you start receiving testosterone replacement therapy, your body will naturally convert some of that testosterone to estradiol.

That’s why conscientious and knowledgeable hormone replacement doctors will often prescribe a drug called anastrozole (trade name Arimidex) to combat estrogen. The drug is categorized as an anti-aromatase and it prevents the aromatase enzyme from pulling the old switcheroo on testosterone.

Consequently, a man receiving the proper dose of Arimidex will stay in the physiological estrogen sweet spot, which keeps him from suffering any of the maladies associated with high levels of the hormone.

Of course, the bottom line is that every adult male over 30 should know what his estrogen levels are, regardless of whether or not he’s on testosterone replacement therapy. The health implications are too severe and the fix for levels that are out whack is too simple for you to live with your head in the sand.